Search

Introduction: In 1996, the NINDS (National Institute of Neurological Disorders and Treatment of Acute Stroke) published targets for the management of patients with acute cerebrovascular events, setting a time of 3 h or less for administration of thrombolytics, creating the Code Stroke. Objective: Evaluate the time between onset of symptoms and arrival at the emergency department of a hospital as prognostic factors in patients with cerebrovascular events attended by the prehospital emergency medical service in the metropolitan area of Monterrey, Nuevo Leon. Materials and methods: Calls received in the ED (EMME) between January and December 2012 were included in a retrospective cross-sectional study, with symptoms showing within the first 8 h or with an unknown onset. The Mann---Whitney test and Fisher's exact test were used. Results: Thirty-six patients were included in the study. In 21, the final diagnosis was cerebral infarction, 5 patients were treated with thrombolysis (23.8%). They were divided into two groups: group 1 died or were left with severe neurological sequelae (n = 9) and Group 2 survived without sequelae or mild neurological sequelae (n = 12). The door hospital arrival time was 67 (29---116) min (Group 1) versus 54 (24---86) min (Group 2) (p = 0.110). The neurological status at the start of the event affected prognosis and mortality (p = 0.018). Conclusions: There are few studies analyzing the time between the inception of the symptomatology and the arrival to the emergency room. In our study 23.8% of this series were thrombolyzed, which puts us in the range of international statistics, compared to the series published by Geffner-Sclarsky et al. The population of this study is small so it is not able to show statistical differences, but the few studies that evaluate the Code Stroke in Mexico open the doors to future work with a larger population in Latin American society. [ABSTRACT FROM AUTHOR]

Background: The recent pandemic has presented several challenges in relation to patient safety with the increase of cognitive, depressive and anxiety symptoms in health workers due to the fear of being infected from COVID-19., Objective: To determine the relationship between anxiety, depression and fear of COVID-19, with the perception of the patient safety environment in medical residents., Material and Methods: Observational, cross-sectional, prospective and analytical study. 258 subjects were surveyed. Medical residents who agreed to participate, whose age or sex was of no importance, were included. It was assessed the perception of the patient safety environment through the self-administered Agency for Healthcare Research and Quality (AHRQ) questionnaire; the depression and anxiety symptoms by using Beck's self-applied inventories for each entity, and the fear of COVID-19 by using a scale developed with the same name. The Pearson correlation coefficient was calculated., Results: A negative linear relationship was found within most of the dimensions explored by the AHRQ questionnaire and the Beck Anxiety Inventory. This relationship was observed too with the Beck Depression Inventory, except in 3 of those dimensions. No statistically significant relationship was found in the Fear of COVID-19 scale., Conclusions: There is a relationship between the degree of anxiety and depression symptoms in residents with the results in the AHRQ questionnaire; however, this result is not reproducible with the Fear of COVID-19 test or other sociodemographic measurement parameters., (© 2022 Revista Medica del Instituto Mexicano del Seguro Social.)

Objective: To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity., Design: A retrospective, longitudinal and analytical cohort study was carried out., Setting: Medical-surgical intensive care unit (ICU) of a tertiary hospital., Patients: Pregnant or puerperal patients of any age admitted to the ICU., Interventions: Calculation of prognostic scores upon admission., Variables of Interest: APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality., Results: A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality., Conclusions: The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration., (Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Introduction: Thyroid cancer represents 2% of all childhood malignances. Its incidence rises 1.1% per year. In comparison with adults, childhood thyroid cancer is detected in a more advanced stage, but with a survival rate above 95%. The objective of this study was to evaluate whether there are factors associated with advanced stages of thyroid cancer in pediatric patients., Results: Nineteen patients were included, 13 (68.4%) were female and six male, all between 7-15 years, with a median of 11 years. Fifteen in advanced and four in early stage. The median age of patients in advanced stage at time of diagnosis was 10.6 years (7-15) and 13.2 (12-14) were in early stage (p=0.075). There was a delay of nine months to get a diagnosis in advanced stage, and 7.2 in early stage (p=0.931). Three of the patients with advanced stage and two with early stage were from Nuevo León (Mexico) and the rest were foreign (p=0.567). In the group with advanced stage, two had thyroid cancer familiar history, and none in the early stage group (p=0.452). Nine patients in advanced stage and three in early stage presented thyroid nodule as the first sign of illness. Six patients in advanced stage and one in early stage presented goiter (p=0.590). None of the studied patients had radiation history. Six patients in advanced stage and one in early stage suffered from Hashimoto's Thyroiditis (p=0.590). Eleven in advanced stage and one in early stage had papillary histologic variety. Four in advanced stage and three in early stage had papillary histologic variety with a follicular patter (p=0.083). Eight patients presented lung metastasis at time of diagnosis (p=0.061)., Conclusions: There are no factors associated with advanced stage thyroid cancer in pediatric populations. Although half of studied patients presented lung metastasis, treatment response and survival is satisfactory.

Objective: To evaluate the effectiveness of trabeculectomy trabeculotomy in the reduction of intraocular pressure in patients with primary congenital glaucoma., Material and Methods: A pre-experimental before and after study was conducted with several measurements after; patients with intraocular pressure≥21 mmHg were included, of both sexes, and children under six years, which had ​​the trabeculotomy trabeculectomy. Success was defined as the reduction of intraocular pressure<21 mmHg within three months after the procedure. For the descriptive analysis, medians with ranges and quartiles 25 and 75 were used. For the inferential analysis, we conducted a visual graphic and analysis of variance for repeated measures of Friedman. A value of p<0.05 was considered as significant. The software used was SPSSv15., Results: 16 eyes were included with intraocular pressure 27.75 mmHg (23-40), vertical and horizontal corneal diameter of 14 mm (12-16), who had undergone trabeculectomy with mitomycin C trabeculectomy; at three months after surgery the intraocular pressure was 12.5 mmHg (8.5-23) (p<0.001) and no changes were observed in the corneal diameters. An eye with a flat anterior chamber was observed as an adverse effect. Thirteen eyes required topical hypotensors to achieve the target intraocular pressure., Conclusions: The treatment with trabeculectomy trabeculotomy in primary congenital glaucoma is effective in the reduction of the intraocular pressure.

Objective: To determine whether prolonged exposure to antibiotics (>5 days) increases the risk of late-onset sepsis (LOS) in newborns of 1,000-1,500 g., Methods: A cohort study in newborns with suspected perinatal infection, with a survival greater than seven days. The exposed cohort was composed of newborns with antibiotic therapy initiated at first postnatal day, lasting >5 days, with negative blood cultures before the fifth day of life, and without clinical evidence of sepsis. The non-exposed cohort was identical but with antibiotics stopped before the fifth day of life. Patients were followed daily for clinical and laboratory evidence of LOS. Others risk factors for LOS were analyzed., Statistical Analysis: We analyzed the incidence, the relative risk (RR) with 95% CI. To measure the time to occurrence of an event of LOS after exposure, Kaplan-Meier survival curve and log-rank test were used., Results: We followed up 49 patients in each group. The incidence was 33.6%. The time of follow-up was 839 vs. 1,291 person-days. Prolonged exposure to antibiotics was associated with a higher risk of LOS (RR: 21.1; 95% CI: 6.5-68.9; p=0.000). The late-onset sepsis-free time was 17.1±1.1 vs. 26.3±0.8 days., Conclusions: The risk of LOS was higher in newborns with prolonged exposure to antibiotics and increased with the days of exposure.

Introduction: Zoledronic acid or zo/edronate is a potent bisphosphonate that recently has been used in children with osteoporosis and osteogenesis imperfecta (01), so it could be an option in the treatment of children with this terrible disease that virtually condemns them to a life of pain and prostration. The aim of this study was to evaluate the clinical and biochemical conditions of pediatric patients with 01 before and after treatment with zo /edronate., Results: We included 14 patients, median age six years (6 months to 14 years), eight (57.1 %) males and six (42 .9%) females, weight 19 kg (5.8-45 kg). According to the type of 01, six (42.9%) were type I, six (42.9%) type Ill, and two (14.2%) type IV The functional score (Bleck) previous to treatment was 4 (1-9) and 6 (2-9) after treatment (p = 0.001). Pain intensity prior to zo/edronate was 2 (1-9) and 0 (0-2) after (p = 0.008). Previous fractures five (1-15) and post-treatment one (0-2) (p = 0.001 ). There were no significant differences in calcium, phosphorus, alkaline phosphatase, and parathyroid hormone., Conclusions: Zoledronic acid decreases the number of bone fractures and pain in children with osteogenesis imperfect and improves functional status. The most common side effects were fever and bone pain within five days after the infusion,which disappear paracetamol. No adverse long-term effects such as hypocalcemia or hypoparathyroidism were reported.

Background: Coccidioidomycosis is a systemic fungal disease caused by Coccidioides spp. Patients with phagocytic, cellular, or humoral immunodeficiencies exhibit immunodeficiencies that confer increased susceptibility to fungal infections. In Mexico there is an underreporting of this disease and no studies currently describe the immune status of these patients in an endemic area., Objective: To describe the clinical and immunological characteristics of pediatric patients with coccidioidomycosis., Materials and Methods: Pediatric patients with diagnosis of coccidioidomycosis from two tertiary level hospitals of northeastern Mexico were included, from the period 2008-2012; immune status was assessed by clinical history, immunoglobulins levels, levels of lymphocytes T, B, and NK (natural killer), and the nitroblue tetrazolium test., Results: Thirty patients were included, 18 male (60%). The age at diagnosis was five years (median, range 0.25-13). Twelve were from Coahuila (40%). Residual pulmonary coccidioidomycosis was the clinical type presentation found in 16 patients (53%). A primary humoral immunodeficiency was found in three patients (10%) and a secondary immunodeficiency in another three (10%). Case fatality rate was 16%., Conclusions: . The disease predominated in male patients. In 33% of patients, levels of IgG were elevated, probably due to stimulation by chronic fungal infection. In 20% of patients, immunodeficiency was documented. There was a high mortality rate.

Objective: to determine frequency, serotypes, biotypes and susceptibility to eight antibiotics in Haemophilus influenzae nasopharyngeal isolates in children under five years old from Mexico City., Methods: cross-sectional survey including children two months to five years old. A nasopharyngeal sample was taken. Haemophilus influenzae identification, serotyping, biotyping and antimicrobial susceptibility were performed., Results: a sample of 573 children were included. In 88/573 (15.3 %) H. influenzae was isolated, corresponding in 7/573 (1.2 %) to Hib, 3/573 (0.5 %) to Hi a, c, d, f and 78/573 (13.6 %) to Nontypable Hi. Among Hib carriers, 6 had received only one or two doses of specific vaccine. Biotype VIII (76.1 %) was the predominant. All isolates were susceptible to the antibiotics, but one Hib strain was resistant to erithromycin., Conclusions: nontypable Haemophilus influenzae was predominant. Colonization by Hib in children under 5 years old was low (1.2 %), occurring in children with an incomplete vaccination schedule.

Background: Adverse effects associated with highly active antiretroviral therapy (HAART), particularly protease inhibitors (PIs), have been identified in adult and pediatric patients. In this study, we monitored, for cholesterol and triglyceride levels, a cohort of HIV-1-infected children receiving a HAART regimen., Methods: HIV-infected patients <17 years old belonging to a cohort that has been followed since 1997 were enrolled in the study. Patients were receiving either a three- or four-drug antiretroviral regimen that included two nucleoside reverse transcriptase inhibitors (lamivudine and zidovudine) combined with one or two PIs (ritonavir and/or saquinavir). Cholesterol and triglyceride levels were measured on fasting serum samples drawn at the time of enrollment and every 3 months thereafter. Clinical evaluation was performed on a monthly basis., Results: Twenty four patients were included. Median age at HIV infection diagnosis was 15 months. Twenty one patients received a four-drug antiretroviral regimen, while three patients received ritonavir plus zidovudine and lamivudine. Median follow-up was 27 months; 62.5% of patients had hypercholesterolemia and 79.2% had hypertriglyceridemia, most typically after 15 months of treatment. None of the patients had physical changes in body fat distribution suggesting lipodystrophy., Conclusions: Hyperlipidemia is a frequent complication in HIV-1-infected children undergoing antiretroviral treatment that includes PIs. Additional studies with larger cohorts and a longer follow-up are needed to propose a rationale and alternatives for patients who develop dyslipidemia while receiving PIs.

Background: To measure HIV-1 RNA concentration requires venous extraction of blood, use of RNAase-free materials, and transport in a cold chain, which makes difficult the management of samples in developing countries. We evaluated the utility of the determination of HIV-1 RNA concentration in blood samples dried on filter paper (DBS) and subjected to different conditions, as contrasted with determination in plasma., Methods: HIV-1 RNA concentration was determined in HIV-infected patients in DBS and in plasma samples. Samples were subjected to the following: DBS were stored at 4, 22, and 37 degrees C for 1, 3, and 7 days; samples from patients from four regions of Mexico were mailed to a reference laboratory; DBS were sent under environmental conditions; and plasma samples were sent frozen. HIV-1 RNA concentrations were determined by NucliSens in DBS and by Amplicor test in plasma., Results: HIV-1 RNA concentration determined in DBS subjected to different temperatures and times had a significant correlation (r=0.99) with those obtained in plasma. When compared with values in plasma, Kappa agreement coefficients of values in DBS stored for 7 days at 4, 22, and 37 degrees C were 0.98, 0.83, and 0.94, respectively. Quantification of HIV-1 RNA in 108 DBS mailed from remote areas with different climates demonstrated significant correlation with those obtained in plasma (r=0.95; p <0.001)., Conclusions: DBS is a simple and reliable method to measure HIV-1 RNA concentration, especially when samples are mailed from remote areas to a reference center. This collection method is an economic and suitable alternative for use in developing countries.

Background: Group B streptococcus, or Streptococcus agalactiae, is a grampositive coccus related to infections in the mother and the newborn during peri and postnatal period., Objective: To describe the prevalence of S. agalactiae serotype III and the susceptibility to antimicrobials in strains isolated from pregnant women., Material and Methods: Cultures from vagina, rectum, and urine were taken from 123 high risk pregnant women, who attended to a Gynecology and obstetrics hospital from June 1st to August 30, 2000. Samples were cultured on 5% sheep blood agar and selective broth. For comparison purposes, we also studied 25 S. agalactiae strains from non-pregnant women isolated from January 2000 to August 2001. Serotyping was performed by latex agglutination and susceptibility testing by Kirby Bauer method., Results: The prevalence of S. agalactiae carriers in pregnant women was 13% and the serotypes were: I (58.8%), II (29.4%), III (5.9%) and non typeable (5.9%). Serotypes from non-pregnant women were: I (68%), II (4%), and III (28%). In both groups, the intermediate resistance to penicillin was 17.6 and 12%, whereas for ceftriaxione was 17.6 and 20% respectively. Resistance to both clindamycin and erythromycin was lower than 4%., Conclusions: The prevalence of S. agalactiae in pregnant women was low and similar to other studies reported in Mexico. Serotype I was the most frequently isolated. Resistance to clindamycin and erythromycin was low, whereas intermediate resistance to penicillin and ceftriaxone was high. The low prevalence of both Streptococcus agalactiae and associated infections in Mexico could be related to racial factors or immunity due to early exposure to that bacterium.

Objective: To assess the prevalence of IgG antibodies against Group B streptococci (GBS) among women of reproductive age in Mexico., Material and Methods: Serum specimens were drawn from 15 to 40 year-old women, representative of all regions and socioeconomic levels of the country. The sample was randomly selected from Banco Nacional de Sueros (National Sera Bank); serum samples were collected during a national seroepidemiologic survey conducted in 1987-1988. The assays for standardization and for evaluation of seroprevalence were carried out at the Hospital de Pediatría del Centro Médico Nacional Siglo XXI (Children's Hospital) Instituto Mexicano del Seguro Social (IMSS) (Mexican Institute of Social Security) from January to November 1995. IgG antibodies against group B antigen were studied with an enzyme-linked immunosorbent assay (ELISA) developed in our lab. Group B antigen was produced and purified from the reference strain GBS 110., Results: A total of 2669 serum samples were studied; 2405 were positive to anti-group B antigen IgG antibodies, for a seroprevalence of 90.2%. No differences in prevalence were found among the different age groups or among the different states of the country., Conclusions: The high seroprevalence of antibodies against GBS suggests that young women in Mexico are commonly exposed to GBS infection.

The aim of this study was to evaluate the utility of a volume-modified blood culture system to diagnose bacteremia in newborns and infants. A total of 793 paired blood cultures, obtained from 464 patients (173 newborns and 291 infants), were analyzed. Vacutainer tubes containing 18 ml supplemented peptone broth sodium-polyanethol-sulfonate were used as the gold standard, in comparison with a blood micro-culture system containing 1.8 ml of the broth. Prior to antibiotic treatment, 2.2 ml of blood was obtained from each patient; 0.2 ml was inoculated in a blood micro-culture tube and 2 ml in a routine tube. Sensitivity, specificity and predictive values were calculated. Microorganisms were isolated in 153 standard blood culture tubes and 151 blood micro-culture tubes. The sensitivity of the blood micro-culture system was 95%, specificity 99% and positive and negative predictive values 96% and 99% respectively. The sensitivity and specificity of blood micro-culture in neonates and infants is high. We recommend that this system be used for the diagnosis of bacteremia in newborns and infants in laboratories where manual systems are still in use.

We describe retrospectively the experience with 44 cases of AIDS from January 1987 to October 1991 at the Instituto Nacional de Pediatria, a tertiary care children hospital in Mexico City. All patients with 2 ELISA and a positive Western Blot test were included. Thirty three patients were infected perinatally (75%) and 11 through blood transfusion (25%). Fourty one patients belonged to the P2 classification of the Centers for Disease Control. Chronic diarrhea (77%), lymphadenopathy (75%), hepatomegaly/splenomegaly (70%) and oral candidiasis (61%) were the most common clinical findings. Twenty patients died (45.4%). No statistical relation were found between survival rate and the way of transmission and age at onset. Autopsy was performed in 14 patients and revealed a sharp decrease of lymphoid tissue at all levels with severe thymic atrophy.